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LiANU USE REPORT %, APP#,.Llfl <br /> EHD RECEIVED APP.REFERRAL: j. -9-g9 COMPLETE & SUBMIT BY <br /> DATE <br /> DATE <br /> ATTN: [ L,U o n't <br /> SITE ADDRESS: / a qq 6 e-,P, ,,..e,- 1 Mg 1 <br /> o -Land Use Check Of List: /gation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> id you use correct Land Use#? 3 J �SSary1 on <br /> id you proofread the report? � <br /> an attached piece of plain paper, draw completed map of area <br /> id you use correct condition(s)#?L in of house, wind direction, etc.... <br /> Did you log it as completed? Is <br /> ruDllc watci. Public sewage: <br /> SUMMARY OR COMMENTS: <br /> (oti rtRc t{aK � Na Rigwr rs ��wt� <br /> C�yi <br /> � Posst B[F aS�.l ru e 5� srt,t� .�— <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br />